• Qiong Sun, Qinchen Gu, Haixu Jiang, Weizhong Li, Zhimin Lin, Chen Li, and Zhenhua Ying.
• The Second College of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang 310014, China.
• Medicine (Baltimore). 2024 Jul 19; 103 (29): e38848e38848.

BackgroundRecently, JAKi has also been widely proved to be an effective alternative to conventional treatment for Synovitis acne pustulosis-hyperostosis-osteitis (SAPHO) cases, after failure of multiple drugs including those described above. But what to do when all these treatments fail? We report a case of remission from Tripterygium wilfordii Hook (TwHF) treatment.MethodsThe patient was treated with nonsteroidal anti-inflammatory drugs, oral prednisone, minocycline, bisphosphonate injection, etanercept, and tofacitinib, but the symptoms did not change significantly. Treatment with TwHF (1.0 mg/kg/day, patient weight 60 kg) was started for 24 weeks.ResultsAfter 50 months of unsatisfactory treatment, this patient was finally treated with herbal TwHF, and after 6 months of treatment, the patient's magnetic resonance imaging and inflammatory indexes were significantly improved, indicating that the disease had been better controlled.ConclusionIn this study, TwHF was successful in treating a patient with refractory SAPHO syndrome who was refractory to multiple Western medications without significant adverse effects or toxicities, but further follow-up is needed to determine long-term efficacy. More case reports as well as clinical trials are still needed to confirm whether TwHF can effectively treat refractory SAPHO syndrome.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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